INTRODUÇÃO: A dor coital é definida pelo Manual Diagnóstico e Estatístico dos Transtornos Mentais (DSM-IV), como transtorno de dor sexual, fazendo referência ao vaginismo e a dispareunia. OBJETIVOS: Avaliar o efeito da intervenção fisioterapêutica na dor coital, avaliar a função sexual das mulheres portadoras de dor coital, verificar presença risco para depressão e ansiedade, avaliar o impacto do tratamento fisioterapêutico na função sexual destas mulheres e identificar o número de sessões necessárias para redução da dor coital. MÉTODOS: Trata-se de um ensaio clinico controlado não randomizado que incluiu onze mulheres com diagnóstico de dispareunia e cinco com vaginismo, referenciadas para atendimento no Ambulatório de Estudos em Sexualidade Humana (AESH) do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. A avaliação prévia da dor foi realizada através da escala visual analógica (EVA) e Índice de dor de Mc Gill, para avaliação da função sexual foi utilizado o Índice de Função Sexual Feminina (IFSF). A Escala Hospitalar de Ansiedade e Depressão (HAD) foi utilizada para rastrear sinais de ansiedade e depressão, em seguida foi realizada a avaliação funcional e do tônus dos músculos do assoalho pélvico, pelo Sistema de Graduação Modificada de Oxford. Os recursos utilizados para o tratamento das mulheres foram orientações gerais (visualização dos músculos do assoalho pélvico e percepção corporal e importância das preliminares), auto- relaxamento, alongamento passivo dos músculos adutores do quadril, propriocepção e a massagem intravaginal. RESULTADOS: 81,25% das mulheres apresentavam risco para disfunção sexual e 43,75% para ansiedade, verificou se uma diferença significativa (p<0,05) de todas as medidas de desfecho entre: avaliação inicial e avaliação pós tratamento imediato e entre avaliação inicial e avaliação após seis meses de tratamento. Houve forte correlação positiva entre IFSF e Oxford; forte correlação negativa entre IFSF e Mc Gill, e entre as medidas HAD depressão e Oxford. CONCLUSÃO: O tratamento fisioterapêutico foi eficaz para o tratamento da dor coital. Contribuindo para melhora da função sexual, redução do risco para disfunção sexual ansiedade e depressão de mulheres com dispareunia e vaginismo. / INTRODUCTION: Coital pain is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), as a disorder of sexual pain, referring to vaginismus and dyspareunia. OBJECTIVES: To evaluate the effect of physiotherapeutic intervention on coital pain, to evaluate the sexual function of women with coital pain, to verify the presence of risk for depression and anxiety, to evaluate the impact of physiotherapeutic treatment on the sexual function of these women and to identify the number of sessions required to reduce Coital pain. METHODS: This was a randomized non- controlled clinical trial that included eleven women diagnosed with dyspareunia and Five with vaginismus, referenced for care at the Ambulatory of Studies on Human Sexuality (AESH) of the Department of Gynecology and Obstetrics of the Medical School of Ribeirão Preto, University of São Paulo. Pre-assessment of pain was performed using the Visual Analogue Scale (EVA) and Mc Gill Pain Index. The Female Sexual Function Index (IFSF) was used to assess sexual function. The Hospital Anxiety and Depression Scale (HAD) was used to track signs of anxiety and depression, and functional and pelvic floor muscle tone assessment was performed by the Oxford Modified Graduation System. The resources used to treat women were general guidelines (visualization of the pelvic floor muscles and body perception and importance of the preliminaries), selfrelaxation, passive stretching of the adductor muscles, proprioception of the hip and intravaginal massage. RESULTS: 81.25% of the women had a risk for sexual dysfunction and 43.75% for anxiety, and a significant difference (p <0.05) was found between all the outcome measures between: initial assessment and immediate post-treatment evaluation and between Assessment and evaluation after six months of treatment. There was a strong positive correlation between IFSF and Oxford; Strong negative correlation between IFSF and Mc Gill, and between HAD depression and Oxford measures. CONCLUSION: Physiotherapy treatment was effective for the treatment of coital pain. Contributing to improved sexual function, reduced risk for sexual dysfunction anxiety and depression of women with dyspareunia and vaginismus.

Equine coital exanthema (ECE), caused by equid herpesvirus 3 (EHV-3), is a contagious venereal disease characterised by the formation of painful papules, vesicles, pustules and ulcers on the external genitalia of both mares and stallions. EHV-3 is an alphaherpesvirus, distinct from the other equine herpesviruses, endemic in most horse breeding populations worldwide. EHV-3 is primarily transmitted through coitus, although there is also evidence supporting the possibility of non-coital spreading through infected fomites and contacts other than coitus. The infection does not usually result in systemic illness. Epidemiological observations and serological monitoring suggest the existence of latently infected animals from which EHV-3 is periodically reactivated and transmitted to cohorts but latency of EHV-3 has not been formerly demonstrated. The negative impacts of ECE on equine breeding enterprises are the forced, temporary disruption of the mating activities of mares and stallions, the additional care and supportive treatment in affected horses, and the risk of virus spread by either fresh or frozen semen as well as by artificial insemination and embryo transfer practices. In intensively managed stud operations, which have heavily-scheduled breeding dates for thoroughbred stallions, breeding disruptions may translate into significant end-of-season decreases in the number of entries into the mare book of affected stallions. Also, delayed foaling dates and/or reduced pregnancy rates may occur in mares that miss breeding opportunities due to the disease. Similarly, in the face of an ECE outbreak in artificial insemination and embryo transfer centres, both donor and recipient affected mares show such discomfort that they are reluctant to be inspected, inseminated or transferred, with the consequent loss of opportunity to become pregnant. The additional time and necessary precautions required to manage the donor and receptor mares due to the presence of the disease also have a substantial negative impact. Because ECE is a not a notifiable disease and the diagnosis is made on the basis of typical clinical signs, most cases and outbreaks of ECE remain unnoticed and its true prevalence and economic impact is difficult to assess and is probably underestimated. Therefore, as several aspects of EHV-3 infection are largely unknown and it has severe economic consequences to the horse industry, the general aim of this doctoral study was to increase the knowledge about the biology of EHV-3 infection. The specific objectives were to investigate the iatrogenic transmission of infection and to set up a protocol for experimental reproduction of the disease, to study the reactivation and re-excretion patterns from latency, to evaluate the epidemiological importance of subclinical infections, and to hypothesise about the ECE economic consequences in the current context of the equine industry. During the occurrence of an outbreak of ECE in an embryo transfer centre, approximately 32% (n=35) of the donor mares and 25% (n=125) of the recipient mares showed typical ECE lesions around the anus and on the perineal skin, discomfort, and anorectal lymphadenopathy. EHV-3 was detected in 7 (58%) of the affected mares and specific antibodies in 23 (88%) of the convalescent mares. Since no natural breeding had taken place on the affected mares, it could be hypothesised that the virus spread was a consequence of contamination by means of the gloves or the ultrasonography scanner used. Lymphadenopathy provides a new concern associated with ECE. EHV-3 was isolated from nasal swabs obtained during an outbreak of unilateral rhinitis affecting approximately 40 out of 2000 thoroughbred horses. The fact that an endoscopic examination had been performed in the week previous to the onset of the lesions to evaluate the respiratory tract function was a common finding in all the horses affected. EHV-3 was demonstrated as the etiologic agent of the unilateral rhinitis observed in those 40 thoroughbred horses. The endoscope used for respiratory tract examination was identified as the most likely cause of the spread of the infection. This case is an example of non-genital iatrogenic transmission and reinforces the importance of strict application of hygienic measures in order to reduce the risk of spread of infectious diseases. The virus isolated from this field outbreak as well as that isolated from others were characterized by means of restriction endonuclease (RE) fragment patterns, plaque size and gG gene partial nucleotide sequencing. In the 25 isolates included in the study, different RE patterns were found: two with BamHI (one of them identical to the one of the reference strain), two with Hind III (both different from the one of the reference strain) and one with Eco RI (different from the one of the reference strain). The plaque size was homogeneous between the isolates, and 1.64 and 2.88 times larger than that of the reference strain. Three base substitutions in the gG gene were found at positions 904, 1103 and 1264, which resulted in strains CAT (Australia), AAT (the United States and Brazil), CAG (Argentina) and ACT (Argentina). The RE pattern and the nucleotide sequence of the gG gene obtained revealed that there are genetically distinguishable EHV-3 strains in circulation. Not only the RE patterns, as previously described, but also the nucleotide sequence of the gG gene, could be useful tools for epidemiological studies. The biological implications of these changes are still unknown. Two sets of experimental infection with EHV-3 were carried out under controlled conditions. In the first experiment, two seronegative mares were topically inoculated in the vagina and perineal area with EHV-3. The same protocol was followed in the second experiment in two seronegative and two seropositive mares (the mares which had been included in the first experiment were used six months later). Clinical samples consisted of swabs from the vagina and perineal area, and blood samples were obtained for virological, serological and haematological studies. A scoring system was designed and used for daily clinical evaluation and rectal temperature records from each mare. Neither hyperthermia nor haematological changes were recorded in the mares analyzed. Typical ECE lesions were observed in seronegative animals: the clinical score was 172 and 90 (average score: 131) for the mares included in the first experiment and 160 and 92 (average score: 124) for the mares included in the second experiment. Only slight lesions were observed in the seropositive mares, being the clinical score 53 and 41 (average score: 47). Also, differences were detected in the duration and intensity of virus shedding, being 15 and 9 days (duration) and 105 versus 104 (the highest virus load detected) in the seropositive and seronegative mares, respectively. In one study designed to demonstrate EHV-3 latency and to study reactivation and re-excretion patterns, virus shedding, seroconversion and the presence of a small ECE lesion were observed in one out of two previously naturally infected mares after corticosteroid treatment. EHV-3 was isolated from perineal vaginal swabs of one of the mares, both on day 14 after corticosteroid treatment and along the following 10 days. A small and rounded area of erosion was observed on the left labia of the vulva of the same mare on day 19 after corticosteroid treatment and 5 days after the virus shedding was detected. A significant (four-fold) increase in the antibody titre was found in the mare which shed the virus 28 days after corticosteroid treatment and 14 days after the beginning of virus re-excretion. In concordance with epidemiological observation and serological studies, and in common with other members of the subfamily Alphaherpesvirinae, this study indicates that a state of latency is established after natural infection of EHV-3. A study was carried out to estimate the prevalence of excretion of EHV-3 under field conditions. The virus was detected in perineal-vaginal swabs by real time PCR and specific antibodies were identified by seroneutralization in 14 (6%) and 105 (48%) respectively of 220 thoroughbred mares without clinical signs at the time of breeding. In order to assess the re-excretion patterns of spontaneous reactivation, two seropositive (presumably latently infected) polo mares were kept in isolation for 11 months. Virological investigations on perineal vaginal swabs obtained on a daily basis revealed re-excretion of EHV-3 on two occasions, 3 months apart (each for a 3-day interval) in one of the mares, and on only 1 day in the other mare. Antibodies against EHV-3 were detected with only slight variation during the entire period in both mares. Clear evidence of the existence of EHV-3 shedders in a healthy mare population under both field and isolation conditions is provided. Furthermore, despite the small number of animals included (only two), the study in mares kept in isolation demonstrated that at least two periods of EHV-3 spontaneous reactivation and re-excretion in the presence of serum antibodies were possible in the same animal in an 11-month interval. In conclusion, EHV-3 infections and ECE are still a threat for the equine industry. In the present study, EHV-3 was found in several field outbreaks of ECE in thoroughbred breeding farms; the disease was reported by the veterinarians as a true sanitary problem and thus demands additional preventive measures. In addition, EHV-3 was detected as a not rare event in clinically healthy mares, which constitutes the most relevant finding from an epidemiological perspective. ECE is also a sanitary problem of concern for embryo transfer and routine veterinary practices. The population of EHV-3 latently infected mares which reach up to 50% at the time of breeding deserves special attention. Reactivation of the latent virus is not preventable and those mares can spontaneously reactivate the virus and become a source of infection for highly valuable horses like « shuttle stallions », with the consequent economically negative impact on the equine enterprises. Finally, there is an important need for finding out additional preventive measures including « pen side » diagnostic tools that allow the detection of subclinically EHV-3 shedding mares in order to segregate them from natural breeding and give them an appropriate antiviral treatment before being covered by stallions.

This thesis analyzed if undergraduate students at a Southern university use the term outercourse to describe sexual behaviors that exclude penile-vaginal intercourse. A literature review revealed that no universal definition of outercourse exists and no forward progression toward a more cohesive definition was observed. Furthermore, 22 various sexual behaviors were recognized as possible outercourse behaviors. Following the literature review, a quantitative study with a minor qualitative component was conducted at a large Southern university. For this phase, 426 students responded to a 34-item online survey. After providing basic demographic information, students were asked to select the single term to describe sexual behaviors that do not include penile-vaginal intercourse. Furthermore, students were asked to determine whether or not they would classify 28 various sexual behaviors as outercourse. The respondents were provided space after each behavior to qualify or elaborate upon any uncertainty they had about the classification of a behavior. Frequencies were tabulated for the qualitative responses to each behavior. The number of comments ranged from 2 to 85 and sadomasochistic activity garnered the most comments (85). Frequency statistics were computed for all quantitative variables. Crosstabs were calculated to determine the demographic characteristics of respondents and non-respondents for each behavior. The results revealed that a majority of the respondents were female (67.4%) and heterosexual (95.5%). Respondents preferred the term "fooling around" (63.4%) instead of outercourse (3.4%) to refer to sexual behaviors that exclude penile-vaginal intercourse. The respondents determined ten behaviors to be outercourse, five behaviors to not be outercourse, and 13 behaviors could not be classified due to the lack of a majority response. For each of the sexual behaviors, approximately 25% of the sample did not provide a response. Crosstabs revealed that freshmen students were more likely than their upperclassman counterparts to omit a response to a behavior. In contrast, juniors were most likely to respond to the sexual behavior questions. The findings from this thesis have provided a catalyst for future interdisciplinary research endeavors and practical implications for health educators and medical professionals who work with undergraduate students.

INTRODUÇÃO: A dor coital é definida pelo Manual Diagnóstico e Estatístico dos Transtornos Mentais (DSM-IV), como transtorno de dor sexual, fazendo referência ao vaginismo e a dispareunia. OBJETIVOS: Avaliar o efeito da intervenção fisioterapêutica na dor coital, avaliar a função sexual das mulheres portadoras de dor coital, verificar presença risco para depressão e ansiedade, avaliar o impacto do tratamento fisioterapêutico na função sexual destas mulheres e identificar o número de sessões necessárias para redução da dor coital. MÉTODOS: Trata-se de um ensaio clinico controlado não randomizado que incluiu onze mulheres com diagnóstico de dispareunia e cinco com vaginismo, referenciadas para atendimento no Ambulatório de Estudos em Sexualidade Humana (AESH) do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. A avaliação prévia da dor foi realizada através da escala visual analógica (EVA) e Índice de dor de Mc Gill, para avaliação da função sexual foi utilizado o Índice de Função Sexual Feminina (IFSF). A Escala Hospitalar de Ansiedade e Depressão (HAD) foi utilizada para rastrear sinais de ansiedade e depressão, em seguida foi realizada a avaliação funcional e do tônus dos músculos do assoalho pélvico, pelo Sistema de Graduação Modificada de Oxford. Os recursos utilizados para o tratamento das mulheres foram orientações gerais (visualização dos músculos do assoalho pélvico e percepção corporal e importância das preliminares), auto- relaxamento, alongamento passivo dos músculos adutores do quadril, propriocepção e a massagem intravaginal. RESULTADOS: 81,25% das mulheres apresentavam risco para disfunção sexual e 43,75% para ansiedade, verificou se uma diferença significativa (p<0,05) de todas as medidas de desfecho entre: avaliação inicial e avaliação pós tratamento imediato e entre avaliação inicial e avaliação após seis meses de tratamento. Houve forte correlação positiva entre IFSF e Oxford; forte correlação negativa entre IFSF e Mc Gill, e entre as medidas HAD depressão e Oxford. CONCLUSÃO: O tratamento fisioterapêutico foi eficaz para o tratamento da dor coital. Contribuindo para melhora da função sexual, redução do risco para disfunção sexual ansiedade e depressão de mulheres com dispareunia e vaginismo. / INTRODUCTION: Coital pain is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), as a disorder of sexual pain, referring to vaginismus and dyspareunia. OBJECTIVES: To evaluate the effect of physiotherapeutic intervention on coital pain, to evaluate the sexual function of women with coital pain, to verify the presence of risk for depression and anxiety, to evaluate the impact of physiotherapeutic treatment on the sexual function of these women and to identify the number of sessions required to reduce Coital pain. METHODS: This was a randomized non- controlled clinical trial that included eleven women diagnosed with dyspareunia and Five with vaginismus, referenced for care at the Ambulatory of Studies on Human Sexuality (AESH) of the Department of Gynecology and Obstetrics of the Medical School of Ribeirão Preto, University of São Paulo. Pre-assessment of pain was performed using the Visual Analogue Scale (EVA) and Mc Gill Pain Index. The Female Sexual Function Index (IFSF) was used to assess sexual function. The Hospital Anxiety and Depression Scale (HAD) was used to track signs of anxiety and depression, and functional and pelvic floor muscle tone assessment was performed by the Oxford Modified Graduation System. The resources used to treat women were general guidelines (visualization of the pelvic floor muscles and body perception and importance of the preliminaries), selfrelaxation, passive stretching of the adductor muscles, proprioception of the hip and intravaginal massage. RESULTS: 81.25% of the women had a risk for sexual dysfunction and 43.75% for anxiety, and a significant difference (p <0.05) was found between all the outcome measures between: initial assessment and immediate post-treatment evaluation and between Assessment and evaluation after six months of treatment. There was a strong positive correlation between IFSF and Oxford; Strong negative correlation between IFSF and Mc Gill, and between HAD depression and Oxford measures. CONCLUSION: Physiotherapy treatment was effective for the treatment of coital pain. Contributing to improved sexual function, reduced risk for sexual dysfunction anxiety and depression of women with dyspareunia and vaginismus.

The peri-coital contraceptive pill is a potential method for pregnancy prevention that could be taken in a period before or after unprotected sexual intercourse. However, uptake of a new contraceptive method relies on accessible terminology and frameworks with which to discuss it. I conducted seven focus group discussions across Canada to understand how women talk about different reproductive health technologies, explore the ways these discourses influence language and frameworks women use to talk about peri-coital contraceptives, and identify perceptions of and concerns about this potential method. Women thought the peri-coital contraceptive pill would be a valuable addition to current contraception. They disliked the name ”peri-coital”; although some participants created more resonant names related to unique aspects of this method, many found it challenging to clearly discuss the method with existing language for contraception. Concerted effort to develop terminology that is clearer may help facilitate the eventual introduction of this new contraceptive method in Canada and beyond.

It is routine for the forensic scientist to obtain a genetic profile of an individual from DNA recovered from a biological stain deposited at a crime scene. In contrast, only a limited number of laboratories in the United States have the capability of performing Y-STR analysis in casework. In order to aid in facilitating the transfer of Y-STR technology to the crime laboratory community for operational use, a comparison between commercial products from three main vendors (Applied Biosystems AmpFLSTR Yfiler PCR Amplification Kit, Promega PowerPlex - Y System, Reliagene Y-PLEX 12) and two in-house Y-STR multiplexes (MPI and MPB) commenced. The main intention for this comparison was to ascertain whether commercial Y-STR kits are able to obtain a male profile from difficult samples which have been accomplished with our in-house Y-STR multiplexes; such as mixtures, post coital specimens, and environmental insults. To aid the crime laboratory community an in depth comparison of the three main commercial Y-STR kits began in hopes to glean information in circumstances where Y chromosome polymorphisms may need to be employed. For example, the ability to provide investigators with the numbers of semen donors in multiple rape cases, identification of the genetic profile of the male component in a male/female mixture, and identification of the genetic profile of the male component in an extended interval post-coital sample. The capability of typing Y-STR loci by the crime laboratory community could dramatically affect the admissibility of Y-STR evidence. Therefore, the comparison of commercially available kits is an imperative process by which the scientific community acquires the necessary information to assess the ability of a procedure to obtain reliable results, determine the conditions under which such results can be obtained and define the limitations of the procedure. Thus the information for the study could lend itself to a standard being established amongst Y-STR kits for operational use and/or the production of a new Y-STR kit. One example of how the comparison of the three main commercial Y-STR kits could directly impact a new standard being established is by examining post-coital samples and their extreme limits (>48 hrs) for each kit in which a full male genetic profile was observed and comparing it to other commercial Y-STR kit and in-house Y-STR multiplexes. This would help establish the types of cases where specific Y-STR kits would be most useful, and the parameters in which each kit is able to perform. Thus leading to the development of a highly sensitive Y-STR kit that would be more sufficient to perform with the variety of samples an operational crime laboratory would routinely analyze. The capability of typing Y-STR loci by the crime laboratory community could dramatically affect the admissibility of Y-STR evidence. Therefore, the comparison of commercially available kits is an imperative process in order to inform the forensic community of different Y-STR kits available and their performance through direct comparison using modified SWGDAM validation guidelines.

In the field of forensic biology, the term “time since intercourse (TSI)” is used to describe the approximate time elapsed between an alleged sexual assault and the collection of a Sexual Assault Evidence Collection Kit (SAECK) from a victim. The estimation of TSI, or Post Coital Interval (PCI), can be crucial information for particular cases in which the time between offense and the collection of a SAECK is in question. Oftentimes, forensic scientists must evaluate the significance of biological test results from evidence in SAECKs, but the variability in current literature complicates interpreting these results. Developing a reliable framework to estimate TSI based on a more extensive review of forensic casework would provide investigators with a fundamental tool for estimating a general timeline in which the offense occurred. This information may play an important role in supporting or refuting a narrative, or weighing the significance of the evidence at hand. This study aims to develop a dependable framework for estimating TSI in living victims based on casework received by Boston Police Department (BPD) Crime Laboratory, Boston, MA. Additionally, this study seeks to determine if any significance exists between the victim’s reported post coital activities and the collection of evidence, including the presence of intact sperm cells. The need to expand research on estimating TSI for sexual assault victims using actual forensic casework is crucial to provide a more reliable method for TSI estimation, compared to previous studies, which have generally been based on fertility studies. Between the years of 2009 and 2017, over 1,800 reported SAECKs were submitted to the Boston Police Department for evidence processing. More than 500 of these kits met the qualifications for this study, including: a living victim, smear slides prepared by a medical professional, and the identification of sperm cells during original kit processing. In order to estimate TSI, the smear slides from these cases were microscopically examined for the presence of intact sperm cells with the aid of Kernechtrot Picroindigocarmine (KPIC) stain. Based on casework received by the BPD, the maximum TSI reported for observing intact spermatozoa on vaginal smear slides was 105 hours, with an average collection time of 15 hours. The maximum TSI in which intact spermatozoa were observed on anorectal smear slides was 17.75 hours, with an average collection time of 7.9 hours. The average collection time in which intact spermatozoa on oral smear slides were observed was 6.9 hours, with a maximum reported TSI of 13.5 hours. Moreover, data from this study indicates a positive relationship between the total number of post coital activities completed before kit collection and the passage of time. Overall, this study provides reliable evidence based on actual casework samples for more accurately estimating the timeframe in which sperm evidence can be recovered after intercourse in living victims of sexual assault crimes.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A contracepÃÃo de emergÃncia (CE) à um mÃtodo que evita a gravidez apÃs a relaÃÃo sexual. TambÃm conhecido por âpÃlula pÃs-coitoâ, esse mÃtodo utiliza progestogÃnio na forma concentrada e tem indicaÃÃo reservada Ãs situaÃÃes especiais ou de exceÃÃo, tais como falha conhecida ou presumida, uso inadequado e relaÃÃo sexual sem uso de mÃtodo contraceptivo, bem como em casos de violÃncia sexual. Descrever e analisar o nÃvel de conhecimento e a utilizaÃÃo da CE de usuÃrias do ServiÃo de Atendimento FarmacÃutico (SAC FARMA), de uma Rede de FarmÃcias ComunitÃrias em Fortaleza, CearÃ. Entre os meses de outubro de 2008 a maio de 2009, apÃs o esclarecimento de informaÃÃes sobre pÃlula pÃs-coito atravÃs do SAC FARMA, mulheres usuÃrias ou que tinham intenÃÃo de uso da CE, foram convidadas a participar da pesquisa sobre uso de CE. Para tanto, foi aplicado um questionÃrio e os dados foram incluÃdos no programa estatÃstico SPSS, versÃo 15.0. Das 54 entrevistas feitas, a maioria das mulheres estavam entre a faixa etÃria de 23 e 29 anos de idade (44,4%), solteiras (66,7%) e residentes no Estado do Cearà (66,7%). Tinham renda entre 1 e 3 salÃrios mÃnimos (48,1%) e cursavam ensino mÃdio (50,0%) e superior (42,6%). Pretendiam fazer uso ou utilizaram CE sem orientaÃÃo/prescriÃÃo mÃdica (92,6%) e a maioria (54%) obteve alguma informaÃÃo sobre CE atravÃs de amigos e familiares. Mais da metade (64,8%) afirmou que nÃo era a primeira vez de uso, sendo que 82% relataram utilizar uma ou duas vezes. Com relaÃÃo ao conhecimento sobre o risco de diminuiÃÃo de eficÃcia caso houvesse repetiÃÃo do uso, a maioria (64%) relatou desconhecer essa informaÃÃo. Relataram nenhuma reaÃÃo ou queixa (72%) e 98,1% conheciam outro mÃtodo contraceptivo, sendo o preservativo o mais conhecido (92,6%) e utilizado (84%). Um dos principais motivos para justificar a utilizaÃÃo da CE foi o sexo desprotegido (53,7%). Quando perguntadas atà quanto tempo apÃs a relaÃÃo sexual o mÃtodo pode ser utilizado, a maioria respondeu que pode ser atà 72 horas (56,3%), 25% nÃo souberam responder e 65,6% relataram que a âPÃlula do Dia Seguinteâ nÃo possui efeito abortivo. A maioria das mulheres avaliadas pretendia fazer uso ou utilizar a CE sem orientaÃÃo/prescriÃÃo mÃdica, obteve informaÃÃes sobre a pÃlula atravÃs de amigos e familiares e, alÃm disso, nÃo tinha conhecimento sobre o risco de diminuiÃÃo de eficÃcia se o uso for repetitivo. Estes fatos alertam para que se tenha uma maior preocupaÃÃo em relaÃÃo à possibilidade de uso indevido do medicamento e seu fÃcil acesso nas farmÃcias comerciais. / The emergency contraceptive pill (EC) is a method of the emergency contraception that prevents pregnancy after sexual intercourse. It is also known as the âpost coital pillâ and contains high dose progestin-hormone. The EC can be taken immediately or up to five days after sex if the woman did not use birth control, in cases of suspected birth control failure, or if she was forced to have sex. To describe the level of knowledge and use of EC by users of the Medicine Attendance Service (SAC FARMA) in a network of community pharmacies placed in Fortaleza, CearÃ. In the months October (2008) to May (2009), after each enquiry about the âpost coital pillâ, women who were using or intended to use this pill were invited to participate in a survey on the use of emergency contraception by the application of a structured questionnaire. The data were analyzed with the statistical program SPSS, version 15.0. Of the 54 women interviewed, the majority were aged between 23 and 29 years (44.4%), were single (66.7%) and resident in the State of Cearà (66.7%). (48.1%) had income between 1 and 3 minimum wages, 50,0% higher secondary education and 42.6% had higher education.). Almost all (92,6%) wished to use or have used EC without guidance/prescription and of these the majority (54%) obtained some information about EC through friends and family. More than half (64.8%) said it was not their first time of use, and 82% reported using EC once or twice previously. With respect to knowledge about the risk of loss of effectiveness if the use is repetitive, the majority (64%) were unaware of this information. Most (72%) reported no adverse reaction or other complaints. Also, 98.1% of interviewed reported that they knew other method of contraception, being the condom the most widely known (92.6%) and used (84%). One of the main reasons to justify the use of EC was unprotected sex (53.7%). When asked for how long after intercourse the method can be used, most answered within 72 hours (56.3%), 25% did not respond and 65.6% reported that "post coital pill" has no abortive effect. Most of the women studied wanted to use the EC without prescription and obtained information about EC pill from friends and family. Moreover most women had no knowledge about the risk of reduced effectiveness if the use is repetitive. These findings are of concern as they indicate the possibility of misuse of the EC given its easy access in pharmacies.

Many young women today are concerned about their sexual health; an increasing number of them consult gynaecologists, youth centres (YCs) and general practitioners with vulvar problems such as painful sensations associated with vaginal intercourse (VIC). It is known that some women continue to have VIC despite pain. Theoretically, repeated painful VIC might elicit vaginistic reactions, which may increase the pain and induce vicious circles. Since many clinicians and researchers nowadays notice that pain during VIC often starts at young age, it is important to investigate how pain during VIC starts and is maintained in younger populations. The overall aim of this thesis was to investigate young women’s experiences of ideal sexual situations and pain during VIC. Women aged 13-22 years participated in our studies, which used both quantitative (study I and IV) and qualitative (study II and III) methods. For paper I, a questionnaire was developed and used in a YC sample (n=300); informants for paper II were selected from that sample to participate in qualitative interviews (n=16). Another qualitative interview study for paper III with a complimentary research question was conducted in a different YC sample (n=14). For paper IV, a questionnaire was developed based on the results from study I, II and III to test the hypotheses derived from study II in a sample of female high school students (n=1566). The findings revealed that 65% of the women reported pain related to first VIC. Among those who reported VIC during the previous month, 49% had experienced pain and/or discomfort during VIC during that same period (paper I). In paper IV, 47% of the women reported experience of pain and/or discomfort during VIC, and among those, 47% continued to have VIC, 22% feigned enjoyment, and 33% omitted telling the partner about their pain. In paper II, the women’s reasons for continuing to have VIC despite pain were: striving to reach their ideal image of a woman, characterized as always willing to have VIC; being perceptive of their partner’s sexual needs; and being able to satisfy their partner. In paper IV the hypotheses derived from study II were confirmed and showed, for example that a significantly higher proportion of women who continue to have VIC despite pain than women who did not had difficulty refusing sex when the partner wants it, felt inferior to the partner during sex, regarded the partner’s satisfaction as more important than their own, felt dissatisfaction with their sex life, and feigned enjoyment despite pain. In a multivariate model, continuing to have VIC despite pain was associated with feelings of being inferior to the partner during sex (adjusted OR 1.82; CI 1.10-3.02), dissatisfaction with their own sex lives (adjusted OR 1.76; CI 1.14-2.72) and feigning enjoyment while having pain (adjusted OR 7.45; CI 4.37-12.69). The major reason for continuing to have VIC was that the partner’s enjoyment was prioritized higher than their own (paper IV). In paper III, we found that women without pain during VIC also felt pressure from social norms and demands and had experienced partners “driving their own race”. However, they managed to some extent to resist these unequal gender norms because of their urge to experience pleasure. In conclusion, pain during VIC is a common complaint among young Swedish women, and a high proportion of them continue having VIC despite pain. The women’s notion of prioritizing the partners´ enjoyment before their own illustrates that unequal gender regimes affect young women’s (hetero)sexuality negatively.

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